Update on Medicare-eligible FreedomBlue PPO plan: As you may be aware, Geisinger Medical Center and most Geisinger physicians do not participate in the FreedomBlue PPO network. There are a small number of Geisinger physicians who have been participating in the network; however, as of March 1, 2013, ALL Geisinger physicians will no longer participate in the FreedomBlue PPO network.
This network change applies ONLY to the Medicare-eligible, FreedomBlue PPO group. The active and non-Medicare eligible retiree plan, Highmark PPOBlue, is NOT impacted at all by this change.Retirees in the FreedomBlue PPO plan should contact Highmark directly at 1-866-918-5285 with any questions or concerns.
Regular full-time faculty and staff members are eligible to enroll in Penn State’s Health Care Plan. Part-time/wage payroll employees are eligible for health coverage after two years of service with a minimum of 750 hours each year. Highmark Blue Shield is responsible for administering the health plan.
If you have any children, they are eligible for coverage on your insurance up to the age of 26. Eligibility is regardless of student status, marital status, or ability to have insurance through their employer.
NOTE: If the adult dependent child of the employee is married, only the adult dependent child of the employee is eligible for coverage.
Notification is sent to the employee from the Employee Benefits Division 60 days prior to a dependent turning 26. This notification includes information concerning a dependent child who may be eligible to continue coverage if that dependent is mentally or physically handicapped, so as to be incapable of earning a living when coverage would normally terminate due to age. When your child is no longer eligible, please contact the Employee Benefits Division to inquire about continuing benefits under COBRA.
Employee Medical Plans Used at Penn State Student Health Clinics
Each campus has a student health clinic that is the primary treatment center for Penn State students. Therefore, it is reasonable to expect that dependent students may try to seek treatment from one of these clinics. Since the clinics are responsible for treating students from all over the United Stats and the entire world, they would need to contract with literally hundreds of insurance providers in order to offer any type of network coverage to the patients they see. This is not a reasonable business practice since the cost of dealing with so many insurance companies and processing tens of thousands of claims would drive up the current discounted rate for services.
Therefore, if you have dependents who are also students at Penn State, we suggest that they continue to utilize their family physician or search for a participating provider through the Highmark Provider Directory. In most cases, the student health clinics available to Penn State students will be considered an out-of-network provider with Highmark. Should your dependent student decide to visit a student clinic regardless, it is the patient (or employee) responsibility to submit claims to Highmark for reimbursement.
Pharmacy Network Change for 2013
Effective January 1, 2013, Target and Walgreens retail pharmacieswill no longer participate in the prescription drug network for the Highmark PPOBlue plan. If you currently use one of these pharmacies, you need to transfer your prescription to a network pharmacy.
**Please note that this change DOES NOTaffect the specialty medications being administered through Walgreens Specialty Pharmacy.
Additionally, Express Scripts and Medcohave merged as one company to manage your prescription benefit under your Highmark PPOBlue plan. The combined company is called Express Scripts. Until the renaming process is complete, you may see the name of either company on communications and on the website. There will be no changes to your pharmacy benefit program.
Specialty medications are typically self-administered injectibles, biological agents, biotechnology medications and other prescriptions that are not available at most pharmacies.
- Walgreens Specialty Pharmacy is the exclusive provider for certain specialty medications
- Dispensed in one-month supplies
- Maximum cost $50/month for formulary drugs and $100/month for non-formulary drugs
If you have any questions, contact Highmark Blue Shield at 1-800-914-4384. This is a dedicated line for Penn State faculty and staff.
There are no changes to the 2013 Medical plan except the two enhancements below, as dictated by Health Care Reform:
Enhanced Women’s Preventive Benefits
Highmark will provide 100% coverage for an expanded list of women’s preventive health services. Many of these services are already covered at 100%, but the goal is to promote wellness and prevention of disease and illness. Listed below is a sample of the preventive services that are included for female members:
- Well female visits and preventive exams
- Contraception Counseling
- Most Female Sterilization Procedures
- Human Papillomavirus (HPV) Screening and Testing
- Sexually Transmitted Infections Counseling
- Interpersonal and Domestic Violence Screening and Counseling
Enhanced Prescription Drug Coverage for Contraceptives
The cost-sharing for contraceptives has changed, due to Health Care Reform legislation. All Generic and Brand formulary contraceptives will be covered under the plan with no cost-sharing.In all other instances, such as if you are choosing the brand name drug when a generic is available or you are taking a non-formulary medication, normal prescription drug coinsurance will apply. All FDA-approved contraceptive methods are included in this enhancement.
Health Care Payroll Contribution
2013 will be the second year of the salary-indexed payroll premium contribution method. A sample of the contribution rates for 2013 is outlined below.
Payroll contributions will be determined on your annual base salary as of September 30, 2012. Your new payroll contribution amount will be effective January 1, 2013 and will remain the same for the entire year (Appointments of irregular duration will be adjusted as deemed appropriate when the appointment is updated). The 2013 contribution rates will be reflected after January 1, 2013.
If both the employee and spouse/same-sex domestic partner are employed at Penn State, they have the ability to choose which employee will carry the health benefits and have the corresponding salary-indexed payroll deduction; changes of this nature must by made in ESSIC during Open Enrollment only.
The below grid(s) are sample contribution amounts only. Your own specific, salary-based payroll contribution for 2012 is reflected in ESSIC.
Part-Time Health Care Contribution
Healthcare benefits are available for eligible part-time employees. Eligibility rules can be found in HR policy HR05 – “Regular” and “Non-regular” University Employees. For those part-time employees that are notified they are eligible to participate in the healthcare plan, the rates are shown below.
|Plan Type||Monthly Rate||Bi-Weekly Rate|
Postdoctoral Scholar Health Care Contribution
For postdoctoral scholars interested in participating in the University’s healthcare plan, the rates are shown below. Additional information regarding the benefits for postdoctoral scholars can be found at the Office of Postdoctoral Affairs.
|Plan Type||Monthly Rate|
Summary of Benefits and Coverage (SBC)
As part of Health Care Reform, Penn State has made available to you a Summary of Benefits and Coverage (SBC)for your review. This document summarizes important information about the healthcare coverage option that is offered under the PPOBlue group plan at Penn State. A paper copy is also available, free of charge, by contacting the Employee Benefits Division.
Form W-2 Update
As a part of Health Care Reform legislation, beginning with 2012 tax year, employers will be required to disclose annually the value of the benefits provided by the employer for each employee’s health insurance coverage on the employee’s annual Form W-2. The Payroll Department has already made necessary changes within the payroll system to ensure that Penn State complies with this new requirement and you will see this update on your 2012 Form W-2.
Changes to Your 2013 Taxes
Due to the Patient Protection and Affordable Care Act (PPACA), there will be some changes in 2013 regarding individuals earning more than $200,000 a year, and married couples who earn more than $250,000 per year. Please review the 2013 Medicare Tax Increase changes.
- Penn State Hershey Medical Group State College
- Physical Medicine Authorization
- Overview of Coverage
- Highmark Blue Shield Website
- Medical Coverage Booklet
- Prescription Coverage
- 2013 Medicare Tax Rate Increase
- Locate a Participating Provider
- Finding your Expense Summary
- Preventive Health Schedule
- Health Care Cost Comparison Tool
- BlueCard Worldwide Coverage Card
- Certificate of Creditable Coverage
- Early Retiree Reinsurance Program Notice
- Wellness Profile
- Map to Highmark Office in State College